Does Chiari Malformation Contribute
To Fibromyalgia (FM) Symptoms?
Alarcón GS, Bradley LA, Hadley MN, Sotolongo A, Alberts KR, Martin
MY, Aaron LA, Weigent DA, Gammal T El, Mountz JM, Blaylock JE, Dept of
Medicine, University of Alabama at Birmingham, Birmingham, AL 35394
AIM: Examine relation between FM and Chiari malformation
and compare clinical symptoms and cerebrospinal fluid (CSF) levels of
substance P (SP) in persons with either FM only, Chiari only, or FM and
METHOD: We studied 64 subjects: 30 (29W, 1M)
rheumatology clinic patients who met ACR criteria for FM, 12 (12W, 0M)
community residents who met ACR criteria for FM but had not sought treatment
(nonpatients), 16 (16W, 0M) healthy community controls, and 6 (5W, 1M)
patients with Chiari only and significant bulbar/spinal cord compression
requiring spinal surgery. An experienced neurosurgeon and neuroradiologist
read all subjects’ blinded and coded brain MRI(s) obtained for an
ongoing pain study using standard criteria for presence of Chiari. Patients
and nonpatients completed McGill Pain Questionnaire and Fatigue Severity
Scale. CSF SP (57/64 subjects) measured by RIA. Statistical analyses performed
with chi-square and ANOVA.
RESULTS: Readers reliably (kappa= .64) identified
Chiari in 6 (20%) FM patients, 0 FM nonpatients, 1 (8%) control, and all
(100%) Chiari only patients. FM patients strongly tended to show Chiari
malformation more frequently than FM nonpatients and controls (p= .07).
Chiari only patients showed significantly (p<.0001) higher mean ( +
SE) CSF SP (58 + 22.0 fmale/ml) than both FM patients (22.3 + 1.9) without
Chiari and nonpatients (18.7 + 1.9) who, in turn, showed significantly
higher mean CSF SP (p<.05) than healthy controls (13.3 + 1.4) without
Chiari. FM patients with and without Chiari did not differ in CSF SP (p
+ .91) or ratings of pain (p= .41) and fatigue (p= .98). One FM patient
with Chiari who required surgery for worsening symptoms of compression
did not differ from FM patients without Chiari in pain or fatigue ratings
but showed CSF SP level (41 fmale/ml) similar to those of Chiari only
patients. The control subject with Chiari showed normal CSF SP (3 fmale/ml).
CONCLUSION: (1) Chiari tends to be associated
with FM among rheumatology clinic patients although it generally does
not elevate levels of CSF SP, pain, or fatigue; (2) All FM patients should
be examined for signs of bulbar/spinal cord compression and those with
evidence of compression should be referred for MRI; (3) A small number
of the FM patients with Chiari may require and benefit from surgery.
1997 American College of Rheumatology Meeting, Abstract No. 953